| NPI | 1336443977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: ID N-05306) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WA DE00007291) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 37273) | |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2010-12-22 |