NPI | 1033662937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 31905) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 31905) |
Enumeration Date | 2016-07-27 |
Last Update Date | 2023-07-14 |