NPI | 1811273428 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27527) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 60607) |
Enumeration Date | 2011-10-26 |
Last Update Date | 2017-03-19 |