| NPI | 1790875912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS OR-345-00) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3042-98) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2018-04-27 |