| NPI | 1871383141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 14517) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 14223266-9926) |
| Enumeration Date | 2025-05-09 |
| Last Update Date | 2025-11-29 |