NPI | 1235732751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MA DN10000088) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN25049) |
Enumeration Date | 2020-11-18 |
Last Update Date | 2025-07-18 |