| NPI | 1801395538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE61330238) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.024728) |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2024-08-29 |