| NPI | 1669675385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 50 054893) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.022825) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00202093) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2014-09-29 |