NPI | 1992221493 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 107477) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 060423-01) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-359) | |
Enumeration Date | 2017-08-16 |
Last Update Date | 2022-09-15 |