| NPI | 1578865754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-4449-OR) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 26105) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM DD3413) | |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2013-03-26 |