| NPI | 1609578202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D011883) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN27945) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2023-09-28 |