NPI | 1659389872 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 18587) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 18587) |
Enumeration Date | 2006-08-03 |
Last Update Date | 2023-01-05 |