| NPI | 1932309648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MS 3022-97) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: FL DN 17395) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2011-01-13 |