NPI | 1922691328 |
---|---|
Former Name | WIRAWUT THOTHONG |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 141) |
Additional Taxonomies | 122300000X Dentist (Licence: OK 7688) |
122300000X Dentist (Licence: FL DN26105) | |
Enumeration Date | 2021-02-16 |
Last Update Date | 2024-03-14 |