NPI | 1134612724 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00205878) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34143) |
Enumeration Date | 2018-06-08 |
Last Update Date | 2024-07-18 |