| NPI | 1326102211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ 6573) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 51234029921) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-152c) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-11-02 |