NPI | 1164039293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 36661) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 36661) |
Enumeration Date | 2020-09-23 |
Last Update Date | 2023-07-11 |