NPI | 1053488429 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23015) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 4842) |
Enumeration Date | 2006-11-29 |
Last Update Date | 2021-02-24 |