NPI | 1154586170 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NM DD4194) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 0024099) |
122300000X Dentist (Licence: NY 053883) | |
Enumeration Date | 2008-07-21 |
Last Update Date | 2021-04-08 |