NPI | 1073287132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 12730935-9921) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011074) |
Enumeration Date | 2021-08-03 |
Last Update Date | 2022-04-12 |