| NPI | 1558932517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-5480) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD9990) |
| 122300000X Dentist (Licence: NJ 22DI02950300) | |
| 122300000X Dentist (Licence: FL DN26171) | |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2024-03-19 |