NPI | 1598898355 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA 5809) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 29747) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR 5858) | |
Enumeration Date | 2007-03-13 |
Last Update Date | 2007-07-08 |