| NPI | 1093165920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 38686) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-289) |
| 1223G0001X Dentist, General Practice (Licence: NV 6745) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2022-07-13 |