| NPI | 1033750070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2020030132) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858506) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2020-09-25 |