| NPI | 1114139599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE 60586504) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053094) |
| 122300000X Dentist (Licence: CT 009648) | |
| 1223E0200X Dentist, Endodontics (Licence: WA DE 60586504) | |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2015-09-08 |