NPI | 1801533526 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN26797) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 38393) |
122300000X Dentist (Licence: FL 26797) | |
Enumeration Date | 2022-05-14 |
Last Update Date | 2025-08-18 |