| NPI | 1720217045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA Dn014522) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037823) |
| 122300000X Dentist (Licence: GA 014522) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 28568) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2018-03-17 |