| NPI | 1386401750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2025014259) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044901) |
| 122300000X Dentist (Licence: FL DN31344) | |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2026-08-27 |