| NPI | 1306653118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 7633) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 4498-25) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS OR-6081-25) | |
| Enumeration Date | 2024-12-16 |
| Last Update Date | 2025-06-11 |