NPI | 1710042478 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26298) |
Additional Taxonomies | 122300000X Dentist (Licence: NV 4994T) |
1223G0001X Dentist, General Practice (Licence: CA 39024) | |
Enumeration Date | 2006-12-23 |
Last Update Date | 2015-07-21 |