| NPI | 1003224593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 9534) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12012179A) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2023-04-13 |