| NPI | 1326724394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901602415) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001209) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2025-05-22 |