| NPI | 1386846442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ 6542) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS030803L) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ DI020734) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2007-07-08 |