NPI | 1265960298 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: AK 148425) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D009737) |
Enumeration Date | 2017-06-04 |
Last Update Date | 2023-03-23 |