| NPI | 1982785564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DE G1-0001283) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS036689) |
| 122300000X Dentist (Licence: IA DDS-09066) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 09066) | |
| 1223P0300X Dentist, Periodontics (Licence: DE G1-0001283) | |
| 122300000X Dentist (Licence: PA DS036689) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2016-08-04 |