| NPI | 1336549153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414607) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15767) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2022-01-28 |