| NPI | 1689647307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 1304) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 94) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 1304) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 94) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2007-07-08 |