| NPI | 1023688124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: HI DT-3163) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO DEN.00206089) |
| 1223G0001X Dentist General Practice (Licence: NM DD5464) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2025-03-15 |