| NPI | 1609102052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 14453) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401412461) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC DEN 1000942) | |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2012-07-23 |