| NPI | 1649475773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 11067) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 35499) |
| 122300000X Dentist (Licence: TN 11223) | |
| 122300000X Dentist (Licence: MO 2023041410) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2025-12-11 |