| NPI | 1720571284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-5038) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10136) |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2024-02-28 |