| NPI | 1023028495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE 60156965) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3557) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D9440) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2013-03-28 |