| NPI | 1700950243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-255) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 4331) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2014-06-12 |