| NPI | 1467035329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 2977) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT-2977) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2023-05-31 |