NPI | 1982851630 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 24093) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 24093) |
Enumeration Date | 2008-08-25 |
Last Update Date | 2013-07-10 |