| NPI | 1114269289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 8546867-9922) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D008813) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 62260) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2022-04-25 |