| NPI | 1114669280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MS 4281-22) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 30139940) |
| Enumeration Date | 2022-04-10 |
| Last Update Date | 2024-07-16 |