| NPI | 1003331299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 059428) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: PA DS040346) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02856300) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02856301) | |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2022-01-07 |