| NPI | 1013402320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416677) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL13686) |
| 122300000X Dentist (Licence: MA DL14124) | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-10-31 |