NPI | 1962711606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 25569) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25569) |
Enumeration Date | 2010-09-29 |
Last Update Date | 2020-06-16 |