NPI | 1942823661 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OR D11932) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN25461) |
1223G0001X Dentist General Practice (Licence: MD 17850) | |
Enumeration Date | 2020-05-28 |
Last Update Date | 2024-02-26 |