| NPI | 1265103022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD D1325) |
| Additional Taxonomies | 122300000X Dentist (Licence: SD D1325) |
| 1223D0001X Dentist, Dental Public Health (Licence: SD D1325) | |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2026-07-06 |