| NPI | 1588158554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN27846) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2018017585) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2024-01-18 |