| NPI | 1336300524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD3456) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027756) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2024-05-13 |