NPI | 1467593657 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 11544) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 11,544) |
Enumeration Date | 2007-02-09 |
Last Update Date | 2016-02-26 |