| NPI | 1528419686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12012478A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202976) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2025-10-07 |