| NPI | 1942551957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AL 5847) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5847) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2015-03-02 |