| NPI | 1598931073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DB-2023-0085) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 121671) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2023-11-02 |