| NPI | 1538803820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2024028456) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044012) |
| Enumeration Date | 2022-04-23 |
| Last Update Date | 2024-10-29 |