| NPI | 1326336827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2011010373) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D007997) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2026-06-14 |