NPI | 1285180653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 33768) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040928) |
Enumeration Date | 2016-08-26 |
Last Update Date | 2020-05-29 |