| NPI | 1699405563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 26971) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 26971) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2024-09-19 |