| NPI | 1144533415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401412959) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 15049) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC 1001038) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 25913) | |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2012-05-17 |