NPI | 1396322517 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417315) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 17064) |
1223G0001X Dentist, General Practice (Licence: DC DEN1002171) | |
Enumeration Date | 2021-03-24 |
Last Update Date | 2021-03-24 |