| NPI | 1205216678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401419720) |
| Additional Taxonomies | 125Q00000X Oral Medicine (Licence: VA 0401419720) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2025-11-09 |