| NPI | 1477936771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN015008) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 1427) |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2020-09-11 |