NPI | 1174252324 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7495) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601272) |
122300000X Dentist (Licence: LA 7495) | |
Enumeration Date | 2022-06-05 |
Last Update Date | 2024-07-17 |