NPI | 1437121787 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 28633) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 7289) |
Enumeration Date | 2006-02-02 |
Last Update Date | 2015-08-19 |