| NPI | 1659787158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: TN 12373) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: GA DN122231) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2024-01-02 |