NPI | 1841603602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2014016851) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61104) |
Enumeration Date | 2014-06-09 |
Last Update Date | 2023-04-28 |