NPI | 1477765196 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 24313) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2007011705) |
Enumeration Date | 2007-05-04 |
Last Update Date | 2023-10-20 |