NPI | 1093374233 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN24255) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN24255) |
Enumeration Date | 2019-06-11 |
Last Update Date | 2024-08-01 |