NPI | 1083096788 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-354) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 9441702-9922) |
Enumeration Date | 2015-06-18 |
Last Update Date | 2021-11-23 |