| NPI | 1376987164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 9695) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9695) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2025-07-22 |