| NPI | 1417036583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: UT 142879-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 142879-9922) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2015-06-01 |