| NPI | 1659691319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MT 17491) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MT 17491) |
| 1223G0001X Dentist General Practice (Licence: UT 77314059921) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2023-07-27 |