NPI | 1356757611 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 10685) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 30245) |
Enumeration Date | 2014-07-08 |
Last Update Date | 2019-10-03 |