| NPI | 1508384728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MT DEN-DEN-LIC-30176) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV LL-572-22) |
| 1223G0001X Dentist, General Practice (Licence: UT 10399382-9922) | |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2025-05-06 |