NPI | 1538990973 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 11190) |
Additional Taxonomies | 122300000X Dentist (Licence: KY 11190) |
Enumeration Date | 2024-08-08 |
Last Update Date | 2024-12-03 |