NPI | 1295745248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IA 7320) |
Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NE 5709) |
Enumeration Date | 2006-08-09 |
Last Update Date | 2007-07-08 |