| NPI | 1992087555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413538) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413538) |
| 122300000X Dentist (Licence: IN 12011672A) | |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2022-04-12 |