| NPI | 1841319308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 3189-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3189-01) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2024-11-12 |