| NPI | 1184308918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0442000499) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 28106) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-26 |