| NPI | 1821718222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 4734) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 38924) |
| 122300000X Dentist (Licence: TX 38924) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2024-05-22 |