| NPI | 1245733187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415842) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001820) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2023-08-02 |