| NPI | 1740842764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN22141) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN22141) |
| Enumeration Date | 2019-06-29 |
| Last Update Date | 2019-06-29 |