NPI | 1962046268 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: WI 6001102) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2019037298) |
Enumeration Date | 2019-10-30 |
Last Update Date | 2022-12-29 |