NPI | 1558819706 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 102146) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 32214) |
Enumeration Date | 2016-09-16 |
Last Update Date | 2018-03-17 |