| NPI | 1245200591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 16171) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 16171) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2017-02-01 |