| NPI | 1336628817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0411000079) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.034027) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2025-12-10 |