| NPI | 1770001562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 33745) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12014023A) |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2023-06-20 |