NPI | 1760767230 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27343) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 80174279922) |
Enumeration Date | 2011-10-17 |
Last Update Date | 2018-02-08 |