| NPI | 1306426721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 13408631-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600877) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2023-11-16 |