| NPI | 1013008218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 4915) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 4915) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2011-08-19 |