| NPI | 1740411818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: UT 48103949921) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: UT 4810394-9921) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2023-11-01 |