| NPI | 1356965289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2020015357) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24954) |
| 122300000X Dentist (Licence: NJ 22DI02807400) | |
| Enumeration Date | 2020-06-06 |
| Last Update Date | 2020-08-21 |