| NPI | 1982836607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD3458) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV 5941) |
| 122300000X Dentist (Licence: CA 58388) | |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2011-10-28 |