| NPI | 1497233548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 14356) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10341) |
| 1223G0001X Dentist, General Practice (Licence: IN 1203017A) | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2025-08-03 |