| NPI | 1548303241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 5267) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 3408) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 29562) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2014-02-14 |