| NPI | 1356629059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2021026049) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8385285-9922) |
| 1223G0001X Dentist, General Practice (Licence: KS 61351) | |
| 1223G0001X Dentist, General Practice (Licence: PA DS040267) | |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2024-10-28 |