| NPI | 1598983801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 25317) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN 18941) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 054803-1) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2011-05-31 |