NPI | 1114418217 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: AZ 10002) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 10002) |
Enumeration Date | 2018-05-23 |
Last Update Date | 2022-09-02 |