NPI | 1699128785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D009549) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D009549) |
Enumeration Date | 2016-07-13 |
Last Update Date | 2025-08-19 |