| NPI | 1295355337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014571A) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 3700) |
| 1223G0001X Dentist, General Practice (Licence: TX 39019) | |
| Enumeration Date | 2020-04-18 |
| Last Update Date | 2025-04-24 |