NPI | 1659893857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 17782) |
Additional Taxonomies | 122300000X Dentist (Licence: GA DN015571) |
Enumeration Date | 2017-07-10 |
Last Update Date | 2025-06-24 |