NPI | 1780257576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: IL 019.033875) |
Additional Taxonomies | 122300000X Dentist (Licence: IN 12014007A) |
1223G0001X Dentist, General Practice (Licence: WI 1002626) | |
Enumeration Date | 2021-07-20 |
Last Update Date | 2025-07-07 |