| NPI | 1639329337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 11540) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MT 11540) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2026-06-04 |