| NPI | 1205471497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN29888) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901601670) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 35717) | |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2026-02-11 |