NPI | 1992498844 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13688) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 13421681-8903) |
122300000X Dentist (Licence: UT 13421681-9921) | |
Enumeration Date | 2023-05-29 |
Last Update Date | 2024-08-23 |