| NPI | 1245382159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SD M647) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN 9704) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 7210) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-08 |