| NPI | 1811004013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12010201A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12010201A) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2024-02-05 |