NPI | 1508261264 |
---|---|
Former Name | JOHN MARK AN |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN00203948) |
Additional Taxonomies | 122300000X Dentist (Licence: IN 12012235A) |
122300000X Dentist (Licence: IL 019030490) | |
Enumeration Date | 2014-10-23 |
Last Update Date | 2020-08-12 |