| NPI | 1932543121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 8345190) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 8345190-9922) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2023-01-11 |