NPI | 1447276779 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NC 8601) |
Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: PR 1787) |
Enumeration Date | 2006-07-13 |
Last Update Date | 2022-12-13 |