| NPI | 1326396383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 12446733-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008513) |
| Enumeration Date | 2012-08-24 |
| Last Update Date | 2024-08-23 |