| NPI | 1730597709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28661) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D.007302-C) |
| 122300000X Dentist (Licence: PA DS039738) | |
| 122300000X Dentist (Licence: SC 8352) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2024-05-21 |