| NPI | 1871159681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5240) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 112661329922) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2023-11-28 |