| NPI | 1811359094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ME DEN5010) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE60883290) | |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2023-05-15 |