| NPI | 1861179046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10427) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7967) |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2026-02-19 |