| NPI | 1780257576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.033875) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12014007A) |
| 1223G0001X Dentist, General Practice (Licence: WI 1002626) | |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2025-07-07 |