| NPI | 1508217480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2016018478) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032003) |
| 122300000X Dentist (Licence: MO 2016018478) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2019-03-21 |