| NPI | 1780999003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: FL DN19109) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19109) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2024-03-29 |