| NPI | 1902273139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 9673) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12012414A) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2018-10-30 |