| NPI | 1538685698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NE 7241) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09473) |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2023-04-12 |