NPI | 1629017223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 8286) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 7695) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR 8551) | |
Enumeration Date | 2006-06-06 |
Last Update Date | 2023-03-07 |