| NPI | 1699267021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 9591) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02655300) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS041625) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2023-05-11 |