NPI | 1467403113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS036592) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS036592) |
Enumeration Date | 2006-05-15 |
Last Update Date | 2023-12-14 |