| NPI | 1225230535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 6414895-9921) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 55509) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D7118) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3835-OR) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2009-08-25 |