| NPI | 1851453997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ 7518) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 44405) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 26206) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2013-06-20 |