NPI | 1972624880 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22833) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 22833) |
1223G0001X Dentist, General Practice (Licence: NC 13569) | |
1223G0001X Dentist, General Practice (Licence: CO DEN.00205860) | |
Enumeration Date | 2007-04-02 |
Last Update Date | 2024-02-05 |