| NPI | 1881172062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN27206) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS102821) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2023-08-03 |