| NPI | 1881609535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM dd1956) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM dd1956) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2025-09-11 |