| NPI | 1952422248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013818A) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: IL 021.000832) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 021.000939) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2022-12-02 |