| NPI | 1790073609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN27904) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 1111111111) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2023-08-16 |