NPI | 1922617752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7126) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2020024031) |
Enumeration Date | 2020-07-28 |
Last Update Date | 2025-02-21 |