NPI | 1750991246 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: AZ D010987) |
Additional Taxonomies | 122300000X Dentist (Licence: TN 11295) |
122300000X Dentist (Licence: WA DE61155866) | |
122300000X Dentist (Licence: TX 38111) | |
Enumeration Date | 2020-08-09 |
Last Update Date | 2024-08-14 |