| NPI | 1548561038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM DD3399) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD3399) |
| 122300000X Dentist (Licence: UT 49293029922) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 49293029922) | |
| Enumeration Date | 2010-11-15 |
| Last Update Date | 2011-02-07 |