| NPI | 1518147719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 26171) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4052) |
| 122300000X Dentist (Licence: OK 5572) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2025-11-05 |