| NPI | 1114585486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC DGD10264) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 11364) |
| 122300000X Dentist (Licence: NC 11364) | |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2022-06-29 |