| NPI | 1861632044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9834) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12011265A) |
| Enumeration Date | 2009-02-27 |
| Last Update Date | 2022-07-21 |