| NPI | 1699930321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 5697) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 26510) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 60394) | |
| 122300000X Dentist (Licence: UT 6975643-9921) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2016-12-07 |