| NPI | 1164549325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 104064) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 359751-9922) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2022-06-10 |