| NPI | 1407958317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: SD M459) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WY 808) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CO 104229) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-08 |