| NPI | 1669886982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-4708-OR) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 1569) |
| 122300000X Dentist (Licence: MO 2014017950) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2024-05-09 |