NPI | 1215240007 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS9159) |
Additional Taxonomies | 122300000X Dentist (Licence: TN 9159) |
Enumeration Date | 2010-07-21 |
Last Update Date | 2022-09-02 |