NPI | 1962882548 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: ID D5494) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 8014319-9921) |
Enumeration Date | 2015-06-09 |
Last Update Date | 2024-06-06 |