| NPI | 1700813797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 12997) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 5585) |
| 1223G0001X Dentist, General Practice (Licence: LA 5585) | |
| 122300000X Dentist (Licence: LA 5585) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2023-06-01 |