| NPI | 1023470184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NH 04647) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL12973) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2021-10-12 |