NPI | 1588230403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: ID D-5579) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE61164746) |
Enumeration Date | 2021-06-01 |
Last Update Date | 2025-10-07 |