| NPI | 1750659660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MT 2372) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-4327-OR) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D12480) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 6456-15) | |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2011-12-06 |