| NPI | 1811515323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 7990) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107348) |
| 122300000X Dentist (Licence: TX 36298) | |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2024-08-20 |