| NPI | 1194141895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OH 30.026080) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 30803) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 059651) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS043618) | |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2024-09-03 |