| NPI | 1043417934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN 18230) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22D102266700) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS031546L) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2009-04-07 |