| NPI | 1366024275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 016.0134154) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL14743) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2023-02-12 |