| NPI | 1649824475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN122562) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN122562) |
| 1223G0001X Dentist, General Practice (Licence: FL DN24446) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN24446) | |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2023-11-10 |