| NPI | 1396843058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3908 OR) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 57194) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-07-13 |