NPI | 1417268731 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 28051) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8983) |
1223G0001X Dentist, General Practice (Licence: LA 6118) | |
1223G0001X Dentist, General Practice (Licence: TX 28051) | |
Enumeration Date | 2010-07-01 |
Last Update Date | 2022-10-04 |