NPI | 1720645047 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1858293) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 04488) |
Enumeration Date | 2019-05-22 |
Last Update Date | 2019-06-17 |