NPI | 1750868436 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN DS0000010760) |
Additional Taxonomies | 122300000X Dentist (Licence: TN DS0000010760) |
1223G0001X Dentist, General Practice (Licence: TN DS0000010760) | |
Enumeration Date | 2018-07-25 |
Last Update Date | 2024-08-27 |