NPI | 1235134032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD MD13796) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL D16128) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC 1000783) | |
Enumeration Date | 2005-06-17 |
Last Update Date | 2013-11-05 |