| NPI | 1225413800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D010952) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31296) |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2025-04-02 |