| NPI | 1427052810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12009609A) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8596) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2016-02-17 |