| NPI | 1639736176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014617A) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 061151) |
| 122300000X Dentist (Licence: CO 00205322) | |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2025-03-18 |