NPI | 1154761393 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29540) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS039642) |
122300000X Dentist (Licence: TX 29540) | |
Enumeration Date | 2013-07-02 |
Last Update Date | 2024-06-11 |