| NPI | 1710923537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN123077) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12010693) |
| 1223G0001X Dentist General Practice (Licence: AZ D008679) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2023-10-18 |