| NPI | 1629556097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AL D.7000-C1) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 26636) |
| 122300000X Dentist (Licence: MO 2018025790) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2025-03-18 |