| NPI | 1932717790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WY 769) |
| Additional Taxonomies | 122300000X Dentist (Licence: SD D1042) |
| 122300000X Dentist (Licence: NE 5387) | |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2020-07-17 |