| NPI | 1427668300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 7895) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 167898) |
| 122300000X Dentist (Licence: UT 11778355-9922) | |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2024-08-28 |