| NPI | 1043724610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 1412) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: WY 1412) |
| Enumeration Date | 2017-11-18 |
| Last Update Date | 2017-11-18 |