| NPI | 1114386273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12012489A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33823) |
| 1223G0001X Dentist, General Practice (Licence: KY 10359) | |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2019-12-02 |