| NPI | 1366785602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 6377) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19309) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN19309) | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2022-12-05 |