| NPI | 1366891566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN25065) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858313) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2020-07-06 |