| NPI | 1326429671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203225) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030595) |
| 122300000X Dentist (Licence: TN 10088) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2017-12-11 |