| NPI | 1942416060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-3935) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 2493) |
| 122300000X Dentist (Licence: OR D-6505) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2024-08-12 |