| NPI | 1174837983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT D-6037) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9473) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2024-02-15 |