NPI | 1255010351 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: SC 10906) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.027307) |
1223G0001X Dentist, General Practice (Licence: NC 14075) | |
Enumeration Date | 2023-07-17 |
Last Update Date | 2025-05-21 |