NPI | 1952515967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX TX 21281) |
Additional Taxonomies | 122300000X Dentist (Licence: OK 6555) |
Enumeration Date | 2007-05-09 |
Last Update Date | 2015-05-14 |