| NPI | 1962070730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 39332) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D-0006904-C1) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2023-05-03 |