NPI | 1538803820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MO 2024028456) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS044012) |
Enumeration Date | 2022-04-23 |
Last Update Date | 2024-10-29 |