| NPI | 1023169265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 10426) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 5841-015) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: HI DT-2139) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |