NPI | 1932456084 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29786) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19904) |
Enumeration Date | 2012-08-08 |
Last Update Date | 2022-08-05 |