| NPI | 1386248664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 39787) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4587) |
| Enumeration Date | 2020-11-26 |
| Last Update Date | 2024-09-04 |