| NPI | 1699128785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D009549) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D009549) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2025-08-19 |