| NPI | 1740403559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001209-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT-2535) |
| 122300000X Dentist (Licence: CA 41631) | |
| 122300000X Dentist (Licence: IL 019.031953) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2024-10-29 |