| NPI | 1902928732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12012218) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 7412) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2020-11-08 |