NPI | 1386792604 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 10978) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00006586) |
Enumeration Date | 2007-01-05 |
Last Update Date | 2007-07-08 |