NPI | 1669717849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 31266) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 057356) |
1223G0001X Dentist, General Practice (Licence: VA 0401413140) | |
Enumeration Date | 2012-11-29 |
Last Update Date | 2025-03-04 |