NPI | 1629567284 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17227) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1001883) |
1223G0001X Dentist, General Practice (Licence: VA 0401416443) | |
Enumeration Date | 2018-05-08 |
Last Update Date | 2020-11-07 |