| NPI | 1902117435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN23096) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23096) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2018-03-17 |