NPI | 1558979195 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MA DN1858792) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN23910) |
1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: FL DN23910) | |
1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CT 12897) | |
Enumeration Date | 2020-07-20 |
Last Update Date | 2021-07-01 |