| NPI | 1740342682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MT 2356) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 6377376-9921) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 050699) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3940-OR) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 1395) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2016-03-16 |