| NPI | 1285486282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN10000362) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401419100) |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2024-08-26 |