| NPI | 1508106956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 8705423-9926) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8705423-9926) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2026-07-20 |