| NPI | 1124164272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 0023072) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3769-OR) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE00009740) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 320651-9921) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 19025473) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 5677 - 15) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-08-15 |