NPI | 1316556053 |
---|---|
Former Name | JERDIE MANUEL ALE-SALVO |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.026978) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002383-15) |
Enumeration Date | 2020-07-29 |
Last Update Date | 2024-09-22 |