NPI | 1932724218 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 39647) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AL 6975) |
Enumeration Date | 2020-06-11 |
Last Update Date | 2023-08-24 |