| NPI | 1366072936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013524A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032478) |
| 122300000X Dentist (Licence: CO DEN.00204264) | |
| 122300000X Dentist (Licence: TX 35921) | |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00204264) | |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2022-11-04 |