NPI | 1841497740 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23817) |
Additional Taxonomies | 122300000X Dentist (Licence: MA 21911) |
Enumeration Date | 2007-07-03 |
Last Update Date | 2013-08-28 |