NPI | 1992377808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859208) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60952459) |
Enumeration Date | 2021-07-12 |
Last Update Date | 2022-04-20 |