| NPI | 1306092705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS042919) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 10086) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 056522-1) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2023-05-30 |