| NPI | 1164090346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 4728) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D-0006888-C1) |
| 122300000X Dentist (Licence: MO 2023034426) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2024-03-08 |