| NPI | 1376746776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 20314) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 16493) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 4851) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |