| NPI | 1841592235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014150A) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN21372) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2024-09-25 |