| NPI | 1194265447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN26836) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2016029614) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2025-03-28 |