NPI | 1194189795 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN DS0000010944) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 9758) |
Enumeration Date | 2016-04-09 |
Last Update Date | 2020-01-04 |