| NPI | 1255060083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SD D1369) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7804) |
| 122300000X Dentist (Licence: KS 62124) | |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2026-07-05 |