| NPI | 1215529235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN123275) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS0000012185) |
| 1223G0001X Dentist, General Practice (Licence: GA DN123275) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN DS0000012185) | |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2023-12-26 |