| NPI | 1225247083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2011003001) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5926330) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2011-12-09 |