NPI | 1508359761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34105) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10882) |
1223G0001X Dentist, General Practice (Licence: CO DEN.00203718) | |
Enumeration Date | 2018-06-12 |
Last Update Date | 2018-09-05 |