| NPI | 1720230386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MT DEN-DEN-LIC-4262) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12011154A) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2014-12-26 |