| NPI | 1881580165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2025021095) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.036240) |
| Enumeration Date | 2025-06-14 |
| Last Update Date | 2025-08-20 |