| NPI | 1740849801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2019019709) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2019019709) |
| 1223G0001X Dentist, General Practice (Licence: AZ D011134) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2024-01-03 |