| NPI | 1386887867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401415634) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 10152) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 10152) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 8798) | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2018-03-17 |