| NPI | 1528743804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10103) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7935) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2023-07-05 |