| NPI | 1720621386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 4397) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: AR 4397) |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2019-10-25 |