NPI | 1457638496 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27562) |
Additional Taxonomies | 122300000X Dentist (Licence: TN 9359) |
Enumeration Date | 2011-11-04 |
Last Update Date | 2019-04-23 |