NPI | 1952081051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: AZ D011911) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 109057) |
122300000X Dentist (Licence: NM DB-2023-0196) | |
Enumeration Date | 2023-07-24 |
Last Update Date | 2025-08-20 |