NPI | 1326693243 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OR D11118) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11118) |
Enumeration Date | 2019-08-07 |
Last Update Date | 2023-07-03 |