| NPI | 1982157038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4127) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2016021062) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2023-09-06 |