| NPI | 1649593039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 810ORTHO) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 015196DENTAL) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 445ORTHO) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 6441DENTAL) | |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2010-03-12 |