| NPI | 1306436472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS044437) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044437) |
| 122300000X Dentist (Licence: NJ 22DI02885000) | |
| 1223G0001X Dentist, General Practice (Licence: NV 7482) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02885000) | |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2024-06-13 |