| NPI | 1629017223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 8286) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 7695) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR 8551) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-03-07 |