NPI | 1093268302 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 9873546-9922) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 9873546-9922) |
Enumeration Date | 2016-08-03 |
Last Update Date | 2023-08-24 |