| NPI | 1104716406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 14229617-9926) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 14229617-8903) |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-07-08 |