NPI | 1265695159 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26098) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7576) |
Enumeration Date | 2008-07-09 |
Last Update Date | 2010-11-03 |