NPI | 1952455792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 19281) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 1259) |
Enumeration Date | 2007-01-22 |
Last Update Date | 2009-08-13 |