| NPI | 1295469161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 14240908-9926) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN27163) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2025-09-25 |