| NPI | 1760616510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 8306050-9921) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 58461) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 33506) | |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2018-02-23 |