| NPI | 1225694672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 269) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 7826) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2024-04-29 |