NPI | 1730342676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 23833) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 0023833) |
Enumeration Date | 2008-07-09 |
Last Update Date | 2012-08-14 |