| NPI | 1285031153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000452) |
| Additional Taxonomies | 122300000X Dentist (Licence: ZZ 0000) |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2024-06-06 |