NPI | 1376825083 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 27162) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 27162) |
1223G0001X Dentist, General Practice (Licence: TX 027162) | |
Enumeration Date | 2011-09-20 |
Last Update Date | 2022-03-23 |