| NPI | 1144717240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN23828) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23828) |
| 122300000X Dentist (Licence: TN 10693) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 10693) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2023-11-17 |