| NPI | 1518374743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NE 7179) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 38248) |
| 122300000X Dentist (Licence: NE 7179) | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2022-10-31 |