| NPI | 1720496714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 9037688-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4816) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2022-08-23 |