| NPI | 1821543182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM DD5086) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9835403-9922) |
| 1223G0001X Dentist, General Practice (Licence: GA DN015218) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00206129) | |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2024-11-14 |