| NPI | 1184789117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WA DE00006793) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: ID D3664) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 51885) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WA 6793) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2019-08-28 |