| NPI | 1235134032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD MD13796) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL D16128) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC 1000783) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2013-11-05 |