| NPI | 1619173424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 27915) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 10651) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2006015347) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2012-10-09 |