NPI | 1699377952 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE61215060) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 36860) |
Enumeration Date | 2020-11-12 |
Last Update Date | 2022-07-07 |