| NPI | 1598944340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN27515) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053622) |
| 122300000X Dentist (Licence: TN 8737) | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2023-03-10 |