| NPI | 1336918887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NH 04944) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA DL15968) |
| 122300000X Dentist (Licence: NH 04944) | |
| Enumeration Date | 2023-12-26 |
| Last Update Date | 2024-10-27 |