NPI | 1124003827 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 28942) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 5341) |
Enumeration Date | 2005-12-14 |
Last Update Date | 2018-01-25 |