NPI | 1720725484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE61477776) |
Additional Taxonomies | 122300000X Dentist (Licence: CO Pending) |
Enumeration Date | 2022-05-15 |
Last Update Date | 2025-06-04 |