NPI | 1639528540 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MO 2019008752) |
Additional Taxonomies | 122300000X Dentist (Licence: WI 1001346-15) |
Enumeration Date | 2016-06-10 |
Last Update Date | 2021-10-19 |