| NPI | 1972247591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D15334) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D15334) |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2025-08-11 |