| NPI | 1366235095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 05274) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL ST-000418) |
| 122300000X Dentist (Licence: VT 016.0134381) | |
| Enumeration Date | 2025-05-26 |
| Last Update Date | 2026-03-14 |