| NPI | 1154559870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN18788) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN18788) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2020-11-13 |