| NPI | 1144897885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6001133-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2021021360) |
| 122300000X Dentist (Licence: PA DS043426) | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2023-03-12 |