NPI | 1275142481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2020025301) |
Additional Taxonomies | 122300000X Dentist (Licence: AR 4450) |
Enumeration Date | 2020-07-24 |
Last Update Date | 2024-12-17 |