| NPI | 1285987206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 22487) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056001) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 100032) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 32856) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 10615) | |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2022-07-21 |