| NPI | 1659533883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN20464) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055513) |
| 1223G0001X Dentist, General Practice (Licence: IL 019028854) | |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2024-03-08 |