| NPI | 1083229124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY D-00067) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013688A) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2026-02-04 |