| NPI | 1396069712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4282) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-4282-OR) |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2024-02-13 |