NPI | 1265954648 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NE 7369) |
Additional Taxonomies | 122300000X Dentist (Licence: NE 7369) |
Enumeration Date | 2017-07-07 |
Last Update Date | 2023-05-03 |