| NPI | 1275146755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 242746) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 11831277-9921) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2026-06-25 |