NPI | 1376036467 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34098) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 34098) |
Enumeration Date | 2018-06-13 |
Last Update Date | 2022-10-22 |