NPI | 1255903118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 37348) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 37348) |
Enumeration Date | 2021-07-12 |
Last Update Date | 2024-05-14 |