| NPI | 1043763824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-355C) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 60677153) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA 60677153) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2021-08-12 |