NPI | 1588049233 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: UT 10757585-9922) |
Additional Taxonomies | 122300000X Dentist (Licence: MD 15995) |
Enumeration Date | 2015-07-23 |
Last Update Date | 2018-05-22 |