| NPI | 1609882802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 12970) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DNF000333) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 32688) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-01-08 |