| NPI | 1457732877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601260) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012344A) |
| 122300000X Dentist (Licence: CO DEN.00204227) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2023-02-06 |