NPI | 1194164095 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29659) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS039579) |
122300000X Dentist (Licence: TX 29659) | |
1223G0001X Dentist, General Practice (Licence: PA DS039579) | |
Enumeration Date | 2013-06-24 |
Last Update Date | 2016-11-02 |