NPI | 1588276257 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417175) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN25721) |
1223G0001X Dentist, General Practice (Licence: NJ 22DI02809600) | |
Enumeration Date | 2020-08-23 |
Last Update Date | 2023-07-19 |