| NPI | 1063670032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MT 2384) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MT 2384) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2025-02-19 |