| NPI | 1417075219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |