| NPI | 1255719506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 13550) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19845) |
| 122300000X Dentist (Licence: VA 0401417761) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2024-04-24 |