| NPI | 1992221493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 107477) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 060423-01) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-359) | |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2022-09-15 |