NPI | 1780338665 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OR D11901) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002755-15) |
Enumeration Date | 2022-02-09 |
Last Update Date | 2024-05-29 |