NPI | 1982095220 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31704) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64334) |
Enumeration Date | 2015-02-09 |
Last Update Date | 2022-04-13 |