| NPI | 1912122029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN014039) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 048549) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-158C) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 4682) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2010-09-25 |