| NPI | 1922730308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 38989) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 38989) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401417916) | |
| Enumeration Date | 2022-06-25 |
| Last Update Date | 2024-03-12 |