| NPI | 1669685046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 8429) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NH 3461) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 20088) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 46771) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2009-01-23 |