NPI | 1215348065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32560) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 63081) |
Enumeration Date | 2014-05-14 |
Last Update Date | 2024-10-11 |