| NPI | 1962248708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL D.007657-C1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 111172) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2026-06-30 |