| NPI | 1972735017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 11187) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401007606) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC DEN5374) | |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2009-08-21 |