NPI | 1083960116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE-60603242) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D9752) |
122300000X Dentist (Licence: WA DE60603242) | |
Enumeration Date | 2012-07-26 |
Last Update Date | 2023-05-10 |