| NPI | 1881846236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NC 8712) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NC 8712) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2016-12-06 |