| NPI | 1316465677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10141) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-10141) |
| 122300000X Dentist (Licence: MN D13808) | |
| 1223G0001X Dentist, General Practice (Licence: MN D13808) | |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2023-07-14 |