| NPI | 1316637895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 11057) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12014077A) |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2025-08-18 |