| NPI | 1750506085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TN 9105) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 329104) |
| 122300000X Dentist (Licence: TN 9105) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2022-07-29 |