| NPI | 1811239593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 9637455-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008662) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D008662) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 101180) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2017-02-23 |