| NPI | 1881825933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600864) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.4560 GD) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2026-02-05 |