| NPI | 1851964001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28722) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 12337282-9922) |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2024-03-04 |