NPI | 1265172605 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417938) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2022-04-01 |
Last Update Date | 2023-08-31 |