| NPI | 1043317902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MT 7949) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 8800) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 00202670) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-04-11 |