| NPI | 1780694968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 8831) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12010408) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12010408A) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2014-04-25 |