NPI | 1063424547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 19852) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 19852) |
Enumeration Date | 2006-08-12 |
Last Update Date | 2023-02-20 |