| NPI | 1194143222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NM DD5070) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00202164) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AZ 9414) | |
| Enumeration Date | 2014-04-05 |
| Last Update Date | 2021-09-08 |