| NPI | 1477616050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 6095015) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D11644) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ND 1978) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-10-24 |