| NPI | 1780830687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: ID D-4813-OR) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57470) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 57470) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2023-12-04 |