| NPI | 1699301986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 12854) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN25130) |
| 122300000X Dentist (Licence: FL DN25130) | |
| 122300000X Dentist (Licence: CT 12854) | |
| 122300000X Dentist (Licence: NY 061981) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 061981) | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2026-07-21 |