NPI | 1003336405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 32998) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 32998) |
Enumeration Date | 2017-06-27 |
Last Update Date | 2023-02-09 |