| NPI | 1669889093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS104865) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS104865) |
| 122300000X Dentist (Licence: TX 30222) | |
| 122300000X Dentist (Licence: AZ D010279) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 30222) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D010279) | |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2020-06-30 |