| NPI | 1174145197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401417454) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043836) |
| 122300000X Dentist (Licence: DC DEN2000113) | |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2022-07-13 |