| NPI | 1619272747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PR 2870) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PR 2870) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2026-03-06 |