| NPI | 1780099788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 6258159-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4592) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2023-06-15 |