| NPI | 1740619220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: HI DT-2971) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6553) |
| 1223G0001X Dentist, General Practice (Licence: CA 62843) | |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2022-06-30 |