| NPI | 1669874129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D011715) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008986) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2024-09-18 |