| NPI | 1609098789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM DD3190) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9183) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2022-11-29 |