| NPI | 1851388821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN015621) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN23902) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS030279L) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2022-08-11 |