| NPI | 1356961700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13104) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12013369A) |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2024-09-23 |