| NPI | 1902286255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 11074) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11074) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2024-09-16 |