NPI | 1497137517 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MO 2018044499) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030181) |
Enumeration Date | 2015-06-25 |
Last Update Date | 2024-07-31 |