NPI | 1215285861 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28167) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 28167) |
Enumeration Date | 2012-08-29 |
Last Update Date | 2022-01-28 |