NPI | 1336989151 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD10853) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 14027) |
Enumeration Date | 2024-05-29 |
Last Update Date | 2025-01-13 |