| NPI | 1104959519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NH 3428) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VT 016-0002204) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 22063) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2010-01-20 |