| NPI | 1285180638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415368) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN10001656) |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2022-07-22 |