| NPI | 1578898326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN-9169) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 13260) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D 6652) | |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2022-03-15 |