NPI | 1891706529 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 5336421-9922) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5336421-9922) |
Enumeration Date | 2006-08-10 |
Last Update Date | 2023-02-28 |