| NPI | 1447650858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 34679) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856735) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2024-10-02 |