NPI | 1508217480 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MO 2016018478) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032003) |
122300000X Dentist (Licence: MO 2016018478) | |
Enumeration Date | 2016-06-22 |
Last Update Date | 2019-03-21 |