NPI | 1417416728 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: TX 35081) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 35081) |
1223G0001X Dentist, General Practice (Licence: WA 60795714) | |
1223G0001X Dentist, General Practice (Licence: TX 35081) | |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 35081) | |
Enumeration Date | 2019-03-16 |
Last Update Date | 2023-01-09 |