| NPI | 1295717775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28891) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401410971) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2025-03-05 |