| NPI | 1568936763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: HI DT-2882) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040530) |
| 122300000X Dentist (Licence: CT 12444) | |
| 122300000X Dentist (Licence: WA DE60997067) | |
| 122300000X Dentist (Licence: TX 35909) | |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2021-03-26 |