NPI | 1629181599 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 17923) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53555) |
Enumeration Date | 2006-08-16 |
Last Update Date | 2021-05-26 |