| NPI | 1043399538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10133) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-10133) |
| 1223G0001X Dentist, General Practice (Licence: WI 5971) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2025-01-02 |