| NPI | 1205357357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12012699A) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN R675) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2022-07-21 |