| NPI | 1902059348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN16950) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16950) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2022-11-09 |