| NPI | 1528329372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.024958) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 056003) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: RI DEN03205) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2023-10-16 |