| NPI | 1316191893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 052958) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ DI 24133) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 56605) | |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2024-09-09 |