| NPI | 1730190950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 24311) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4257) |
| 1223G0001X Dentist, General Practice (Licence: HI DT-2364) | |
| 1223G0001X Dentist, General Practice (Licence: OR D8779) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2023-01-13 |