| NPI | 1053710293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN27901) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM DD4636) |
| 122300000X Dentist (Licence: MO 2014021256) | |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2024-01-30 |