| NPI | 1861198251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 4829) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401418288) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 1104544) | |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2025-05-09 |