NPI | 1033561774 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31931) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 31931) |
Enumeration Date | 2016-07-06 |
Last Update Date | 2023-05-31 |