| NPI | 1598293516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AZ D011728) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 10698) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CT 13052) | |
| Enumeration Date | 2017-06-03 |
| Last Update Date | 2023-12-10 |