| NPI | 1205003126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 56923) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: HI 2292) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 5976026) | |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2008-05-14 |