| NPI | 1215240866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 30390) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 63195) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 05492) | |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2022-07-21 |