NPI | 1770008575 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-09530) |
Additional Taxonomies | 122300000X Dentist (Licence: NE 7398) |
Enumeration Date | 2017-08-14 |
Last Update Date | 2020-01-23 |