| NPI | 1326394834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2015015204) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041696) |
| 122300000X Dentist (Licence: NV 6304) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 61097) | |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2020-01-09 |