| NPI | 1881919405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 062946) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT2761) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401412896) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: HI DT2761) | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2023-07-10 |