| NPI | 1376218065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 108456) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: HI DT-2934) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2023-01-06 |