| NPI | 1316153414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 3532) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 3532) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 307) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |