NPI | 1609213396 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 29009) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 29009) |
Enumeration Date | 2013-06-04 |
Last Update Date | 2022-07-21 |