| NPI | 1790907756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 9684) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 9590) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22D100900700) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-07 |