| NPI | 1740606748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20526) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401418773) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 17589) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OH 30.027033) | |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2024-08-08 |