| NPI | 1164592259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 22054) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 54986) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 184) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2012-05-21 |