| NPI | 1609033141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 22328) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV 5069) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 18081) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2010-06-22 |