| NPI | 1699961243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 04531) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10035) |
| 1223D0001X Dentist, Dental Public Health (Licence: NH 04531) | |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2022-10-17 |