| NPI | 1326597238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WI 1001398) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001398) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2025-08-14 |