| NPI | 1629601679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TN 11770) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MS 4405-23) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D012025) | |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2024-06-12 |