| NPI | 1033697107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416239) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23713) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |