| NPI | 1922428101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415112) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9294464-9922) |
| 122300000X Dentist (Licence: SD D1054) | |
| 1223G0001X Dentist, General Practice (Licence: VA 0401415112) | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2024-11-20 |