NPI | 1790529840 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D012396) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DB-2024-0181) |
Enumeration Date | 2024-06-24 |
Last Update Date | 2025-07-30 |