| NPI | 1336511716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 1001113-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001113-15) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2020-10-06 |