| NPI | 1699591354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE61629486) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401419162) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 40978) | |
| Enumeration Date | 2024-11-27 |
| Last Update Date | 2024-11-27 |