| NPI | 1124450036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC DGD.8272) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.8272 GD) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2020-12-28 |