| NPI | 1366428799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 003318) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 003318) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA 013654) | |
| Enumeration Date | 2005-12-18 |
| Last Update Date | 2014-12-11 |