| NPI | 1437991437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 7502) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 007523) |
| 122300000X Dentist (Licence: SC 11541) | |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2026-08-27 |