| NPI | 1316911746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 3156) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AR 3156) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2007-07-08 |