NPI | 1831204007 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: TX 19019) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 19019) |
Enumeration Date | 2006-08-20 |
Last Update Date | 2012-06-12 |