| NPI | 1699400242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN10000985) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT-2984) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2025-08-01 |