| NPI | 1528783339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 39182) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0134125) |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2023-12-28 |