| NPI | 1407925050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 122300000X Dentist |
| 122300000X Dentist | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2008-03-26 |