| NPI | 1760790596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 1201277A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020271) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.028026) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2018-03-17 |