| NPI | 1134502057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 04610) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31360) |
| 122300000X Dentist (Licence: PA DS040545) | |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2024-07-03 |