| NPI | 1043838840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5044) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11723611-9922) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2026-07-20 |