NPI | 1275660037 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: LA 3729) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 3729) |
Enumeration Date | 2007-02-28 |
Last Update Date | 2025-04-25 |