| NPI | 1245466804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NE 7121) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SD D1100) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2014018383) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 60690) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2016-04-06 |