| NPI | 1316099039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D8291) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D8291) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-04-05 |