| NPI | 1669511010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2005031231) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2005031231) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 09238) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 60913) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2023-01-25 |