| NPI | 1922458918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2021014228) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04229) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2023-02-07 |