NPI | 1609229103 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: TN 10250) |
Additional Taxonomies | 122300000X Dentist (Licence: TN 10250) |
Enumeration Date | 2016-07-20 |
Last Update Date | 2023-08-22 |