NPI | 1265815997 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA DNF000405) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 35962) |
Enumeration Date | 2015-06-30 |
Last Update Date | 2022-07-12 |