| NPI | 1790110674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI DT-2695) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62912) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2018-07-31 |