| NPI | 1780390807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40869) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12014107A) |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2024-08-29 |