| NPI | 1003056409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 60349) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 5762) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 27088) | |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2018-11-16 |