| NPI | 1912419706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN22551) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 22551) |
| 1223G0001X Dentist, General Practice (Licence: PA DS041458) | |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2025-02-24 |