NPI | 1639415987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1856141) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 28603) |
Enumeration Date | 2012-12-13 |
Last Update Date | 2015-02-17 |