NPI | 1164592259 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 22054) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 54986) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 184) | |
Enumeration Date | 2006-11-08 |
Last Update Date | 2012-05-21 |