NPI | 1942652250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1857502) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: RI DEN03305) |
Enumeration Date | 2016-07-11 |
Last Update Date | 2024-09-12 |