| NPI | 1437467511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02670900) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NV S3-262) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NV 6084) | |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2022-07-21 |