| NPI | 1821782327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28115) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IN 12014088A) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2023-06-27 |