| NPI | 1467844423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 29918) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29918) |
| Enumeration Date | 2015-02-28 |
| Last Update Date | 2022-02-08 |