| NPI | 1114364692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011963) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9292) |
| 122300000X Dentist (Licence: KY 9292) | |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2023-11-29 |