NPI | 1528743804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10103) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7935) |
Enumeration Date | 2023-06-15 |
Last Update Date | 2023-07-05 |