| NPI | 1326721549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28494) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601933) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2023-12-20 |