| NPI | 1558703819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE60574845) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414951) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401414951) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 31290) | |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2020-09-10 |