NPI | 1225506777 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: FL 26785) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34697) |
Enumeration Date | 2018-11-02 |
Last Update Date | 2023-06-01 |