| NPI | 1417330978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI DT2601) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT2601) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2023-11-02 |