| NPI | 1295301091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D-0007122-C1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2021019860) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2022-10-21 |