NPI | 1497019822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27958) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 27958) |
Enumeration Date | 2012-06-29 |
Last Update Date | 2025-05-13 |