NPI | 1336918887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NH 04944) |
Additional Taxonomies | 122300000X Dentist (Licence: NH 04944) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MA DL15968) | |
Enumeration Date | 2023-12-26 |
Last Update Date | 2025-02-17 |