| NPI | 1770535601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 3253-03) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3253-03) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-07-18 |