| NPI | 1598898355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA 5809) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 29747) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR 5858) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |