| NPI | 1417467069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 36434) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8986) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 8986) | |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2024-08-30 |