| NPI | 1194246835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 016.0133901) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031578) |
| 1223G0001X Dentist, General Practice (Licence: ME DEN4587) | |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2019-06-10 |