NPI | 1447486154 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27724) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2354) |
Enumeration Date | 2009-06-09 |
Last Update Date | 2015-10-01 |