NPI | 1003426081 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36424) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 36424) |
Enumeration Date | 2020-08-05 |
Last Update Date | 2021-06-15 |