| NPI | 1578879961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12012013A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6590-15) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2024-04-09 |