| NPI | 1952894909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 0000010765) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10765) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2023-04-26 |