| NPI | 1366881831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 197) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6527) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2025-07-09 |