| NPI | 1629061072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN16064) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16064) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2021-01-13 |