| NPI | 1336436385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600920) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12011691A) |
| 1223G0001X Dentist, General Practice (Licence: KY 9013) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2024-05-14 |