| NPI | 1184351843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN27184) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033853) |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2024-06-16 |