NPI | 1265574685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 11379) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: DC 5474) |
Enumeration Date | 2007-02-13 |
Last Update Date | 2023-12-22 |