NPI | 1457917767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MD 17754) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 17754) |
1223G0001X Dentist, General Practice (Licence: PA DS042051) | |
Enumeration Date | 2019-05-13 |
Last Update Date | 2025-05-28 |