NPI | 1508424243 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 11997356-9922) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD5098) |
Enumeration Date | 2019-05-29 |
Last Update Date | 2023-01-16 |