| NPI | 1699864520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS OR-050-82) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 1750-77) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2010-09-28 |