| NPI | 1275512683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: VA 0401410682) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401410682) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2023-01-12 |