| NPI | 1740620418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-4629-OR) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6424) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2024-03-16 |