NPI | 1669834172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN13066) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN13066) |
Enumeration Date | 2016-03-23 |
Last Update Date | 2018-05-23 |