| NPI | 1326137191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 60869) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2012022482) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 129) | |
| 122300000X Dentist (Licence: AR 3225) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2013-04-24 |