| NPI | 1952081051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D011911) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DB-2023-0196) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2023-07-24 |