NPI | 1306139514 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30015) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX F-26367) |
Enumeration Date | 2011-05-20 |
Last Update Date | 2017-05-09 |