| NPI | 1780476671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 6001932-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 14230037-9926) |
| Enumeration Date | 2025-05-19 |
| Last Update Date | 2025-08-13 |