| NPI | 1033421169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OH 30.023224) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8931) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2018-08-16 |