| NPI | 1922552116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: KY 1150) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9810) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2022-09-28 |