| NPI | 1497316590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 13378) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1859304) |
| 1223G0001X Dentist, General Practice (Licence: NC 11430) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 11430) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 063210) | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2023-07-27 |