| NPI | 1821060096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM DD3630) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DNO13230) |
| 122300000X Dentist (Licence: NV 5215) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D6946) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS OR-509-16) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-227) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 55580) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2019-06-26 |