| NPI | 1811189012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 12583) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DSO39807) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 048368) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2023-12-04 |