| NPI | 1720222383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA SP 189) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM 1412) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 0183) | |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2016-12-13 |