NPI | 1215360292 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: ID D-4690) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 8690227-9923) |
Enumeration Date | 2013-08-14 |
Last Update Date | 2024-07-10 |