| NPI | 1770797672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-198) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV 5932) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 55589) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2021-07-01 |