| NPI | 1336542299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-340) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 64020) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 36375) | |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2020-09-10 |