| NPI | 1649898016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12013748A) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 36150) |
| Enumeration Date | 2020-07-11 |
| Last Update Date | 2022-12-27 |