| NPI | 1518346352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31417) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040768) |
| 122300000X Dentist (Licence: IN 12012305A) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2022-03-18 |