| NPI | 1023009750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TN 4125) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 4125) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2020-11-05 |