| NPI | 1154422756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D009791) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 6183748-9926) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE00006868) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2026-01-12 |