NPI | 1922098557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD2331) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21057) |
Enumeration Date | 2005-10-25 |
Last Update Date | 2025-07-16 |