| NPI | 1326359266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN03122) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15330) |
| 122300000X Dentist (Licence: RI LD00055) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2020-12-30 |