| NPI | 1558763151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NV LL-433-16) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 30482) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2019-06-25 |