| NPI | 1932499217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN23095) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14770) |
| 122300000X Dentist (Licence: DC DEN1000968) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401413014) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2019-05-23 |