| NPI | 1114933553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: HI DT2689) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: UT 47510529922) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: ID D3738OR) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-09-21 |