| NPI | 1144530841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OH 30.024074) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055280) |
| 122300000X Dentist (Licence: MD 14712) | |
| 122300000X Dentist (Licence: DC DEN1000966) | |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2013-09-04 |