NPI | 1174043764 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 101448) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 101448) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV 7041) | |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-356) | |
Enumeration Date | 2017-06-23 |
Last Update Date | 2022-09-13 |