| NPI | 1346478666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 6994989) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2009014599) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2016-03-19 |