NPI | 1124307426 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 00205531) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 056402) |
Enumeration Date | 2011-08-04 |
Last Update Date | 2023-10-26 |