NPI | 1891978904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23540) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 23540) |
1223G0001X Dentist, General Practice (Licence: IL 019.027518) | |
Enumeration Date | 2007-12-12 |
Last Update Date | 2021-07-23 |