NPI | 1639464662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1855732) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855732) |
Enumeration Date | 2011-06-17 |
Last Update Date | 2024-02-13 |