| NPI | 1003302894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IN 12013073A) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00203595) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2021-02-15 |