| NPI | 1528797776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN27724) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D-0007033-C1) |
| Enumeration Date | 2022-06-05 |
| Last Update Date | 2023-08-31 |