NPI | 1588072391 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MO 2015014360) |
Additional Taxonomies | 122300000X Dentist (Licence: MO 2015014360) |
Enumeration Date | 2014-07-24 |
Last Update Date | 2024-01-30 |