| NPI | 1306446539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 1859560) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0133978EMGY) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2023-03-13 |