| NPI | 1548370224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN122764) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 12558) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 34336) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-12-05 |