| NPI | 1659034932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401417282) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401417282) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 17572) | |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2025-02-26 |