NPI | 1790888733 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2015042811) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 6796) |
Enumeration Date | 2006-09-06 |
Last Update Date | 2023-05-09 |