| NPI | 1275625154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-77) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5030821) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV 4081) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S377) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-11-13 |