NPI | 1255543146 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 13995) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 13995) |
Enumeration Date | 2007-05-04 |
Last Update Date | 2009-11-19 |