| NPI | 1265650618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OH 30017930) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 1001) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ME DEN3154) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |