| NPI | 1356443071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: ID 4901) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019395) |
| 122300000X Dentist (Licence: MS PRV-ML-001-16) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MS OR-521-16) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2018-11-30 |