NPI | 1841630126 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC-9683) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61020) |
Enumeration Date | 2013-07-01 |
Last Update Date | 2021-09-16 |