NPI | 1972070829 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: SC 9586) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 10959097-9921) |
Enumeration Date | 2018-10-30 |
Last Update Date | 2021-10-27 |