NPI | 1235516188 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: FL 23287) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
1223G0001X Dentist, General Practice (Licence: FL 23287) | |
Enumeration Date | 2015-04-29 |
Last Update Date | 2022-08-24 |