| NPI | 1073670394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 6693) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12014034A) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2026-02-06 |