| NPI | 1689680373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NH 3064) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 3064) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2019-12-05 |