NPI | 1700159266 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: ZZ 1403391) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ZZ AE-008082) |
Enumeration Date | 2012-02-14 |
Last Update Date | 2012-02-14 |