| NPI | 1164219366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 18377) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MD 18377) |
| Enumeration Date | 2025-04-22 |
| Last Update Date | 2025-07-17 |