| NPI | 1497952675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 8431) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8431) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2015-11-20 |