NPI | 1396952495 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23149) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 1827) |
Enumeration Date | 2007-05-17 |
Last Update Date | 2024-09-04 |