| NPI | 1386717973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 2609) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 70) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 143) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |