| NPI | 1558979195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1858792) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23910) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN23910) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 12897) | |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2021-07-01 |