NPI | 1093866493 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AL 4132) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 4132) |
Enumeration Date | 2007-01-15 |
Last Update Date | 2022-09-27 |