NPI | 1871145664 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 35464) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 35464) |
Enumeration Date | 2019-07-11 |
Last Update Date | 2019-07-12 |