NPI | 1306092705 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS042919) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 10086) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 056522-1) | |
Enumeration Date | 2008-08-18 |
Last Update Date | 2023-05-30 |