NPI | 1699194092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN21843) |
Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL DN21843) |
Enumeration Date | 2014-04-14 |
Last Update Date | 2020-03-24 |