NPI | 1821135823 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MO 2019038311) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 19-17894) |
Enumeration Date | 2007-01-30 |
Last Update Date | 2022-10-21 |