NPI | 1124627757 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MA DL15521) |
Additional Taxonomies | 122300000X Dentist (Licence: WA 61100349) |
Enumeration Date | 2020-10-24 |
Last Update Date | 2023-02-13 |