| NPI | 1003895558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 104613) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA 009029) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AL 3228) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 4473) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN 006753) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2007-07-08 |