NPI | 1205319274 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41249) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031802) |
1223G0001X Dentist, General Practice (Licence: IL 019.031802) | |
Enumeration Date | 2018-09-14 |
Last Update Date | 2025-06-11 |