| NPI | 1114243334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 8879) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS8879) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2023-04-07 |