| NPI | 1164771341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02515200) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN122649) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 102021) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DN122649) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2024-10-18 |