| NPI | 1780988576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 14696) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412360) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC DEN1000872) | |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2024-01-22 |