| NPI | 1568183473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN122890) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 10315) |
| 122300000X Dentist (Licence: FL DN27476) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN122890) | |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2022-09-12 |