NPI | 1598287484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OR D10680) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36616) |
Enumeration Date | 2017-07-12 |
Last Update Date | 2020-09-23 |