| NPI | 1366978082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN25384) |
| Additional Taxonomies | 122300000X Dentist (Licence: SD D1172) |
| 122300000X Dentist (Licence: UT 10341065-9922) | |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2024-10-05 |