NPI | 1528020914 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27782) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 049653) |
1223G0001X Dentist, General Practice (Licence: PA DS035474) | |
1223G0001X Dentist, General Practice (Licence: PR 2024) | |
Enumeration Date | 2006-04-03 |
Last Update Date | 2022-03-02 |