NPI | 1164937421 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD4823) |
Additional Taxonomies | 122300000X Dentist (Licence: NM DD4823) |
1223G0001X Dentist, General Practice (Licence: CA 103623) | |
Enumeration Date | 2017-12-08 |
Last Update Date | 2022-11-02 |