| NPI | 1841397544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 036819) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI01368400) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS027104L) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2007-07-08 |