| NPI | 1801533526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN26797) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 38393) |
| 122300000X Dentist (Licence: FL 26797) | |
| Enumeration Date | 2022-05-14 |
| Last Update Date | 2025-08-18 |