NPI | 1740641133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33773) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 059261) |
Enumeration Date | 2016-03-11 |
Last Update Date | 2018-06-12 |