| NPI | 1992755078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 34698) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AK 1097) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 5370-015) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2022-10-31 |