| NPI | 1629517719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 10920) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL d.6883-C1) |
| 122300000X Dentist (Licence: SC 8950) | |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2024-08-20 |