| NPI | 1477996718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AK AA - 778) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK DENT778) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2021-08-27 |