NPI | 1144950445 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2024048189) |
Additional Taxonomies | 122300000X Dentist (Licence: AZ D011380) |
Enumeration Date | 2022-06-10 |
Last Update Date | 2024-12-13 |