| NPI | 1689048712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 7036-15) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WI 7036-15) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2022-11-17 |