NPI | 1134493638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27721) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 27721) |
Enumeration Date | 2012-03-01 |
Last Update Date | 2012-12-18 |