| NPI | 1558743328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN24056) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202550) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2022-12-05 |