| NPI | 1831437128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MD 15273) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MI 2901020067) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: GA DN014463) | |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2015-02-20 |