NPI | 1669580726 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 14500) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 4070) |
Enumeration Date | 2006-08-29 |
Last Update Date | 2007-07-08 |