| NPI | 1508271495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AL 6093) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 6093 C1) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2023-02-17 |