| NPI | 1114126836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 8440385-9921) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D7279) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D9240) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 60379) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2013-09-04 |