NPI | 1255999264 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35200) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN24136) |
Enumeration Date | 2019-06-04 |
Last Update Date | 2022-02-01 |