| NPI | 1164954582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicinist (Licence: VA 0401417624) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401417624) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2023-03-09 |