| NPI | 1932388683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: UT 6920699-9921) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IA 08361) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2022-10-27 |