NPI | 1205527264 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17947) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401418377) |
Enumeration Date | 2023-05-18 |
Last Update Date | 2023-05-18 |