NPI | 1801204375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MO 2023028725) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 058375) |
122300000X Dentist (Licence: KS 62032) | |
Enumeration Date | 2014-07-29 |
Last Update Date | 2023-10-11 |