NPI | 1346797941 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1858748) |
Additional Taxonomies | 122300000X Dentist (Licence: CT 11722) |
Enumeration Date | 2016-09-01 |
Last Update Date | 2023-02-13 |