| NPI | 1740331925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN23028) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 40509) |
| 122300000X Dentist (Licence: IN 12011100A) | |
| 122300000X Dentist (Licence: TX 36188) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2021-11-03 |