| NPI | 1689805582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 009054) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE00009909) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 055860) | |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2013-03-20 |