| NPI | 1831473305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 34865) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9033) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN00202177) | |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2024-10-18 |