NPI | 1689151508 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34296) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11987) |
Enumeration Date | 2018-07-24 |
Last Update Date | 2025-08-20 |