NPI | 1497105944 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: ID D-4757) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4757) |
Enumeration Date | 2016-06-15 |
Last Update Date | 2024-03-04 |