| NPI | 1104516855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28911) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D.007194-C1) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2024-04-30 |