NPI | 1699930321 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NV 5697) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 26510) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 60394) | |
122300000X Dentist (Licence: UT 6975643-9921) | |
Enumeration Date | 2008-07-22 |
Last Update Date | 2016-12-07 |