| NPI | 1588982235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 6242) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 3896) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2012-09-24 |