| NPI | 1225481450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN22122) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 22122) |
| Enumeration Date | 2016-07-23 |
| Last Update Date | 2022-04-25 |