| NPI | 1689371635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 00206555) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT-3090-0) |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2026-02-13 |