NPI | 1700195823 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25667) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 25667) |
Enumeration Date | 2010-10-07 |
Last Update Date | 2016-02-29 |