| NPI | 1801577580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 13814366-9926) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044123) |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2025-06-26 |