| NPI | 1417518762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 16991) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416590) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2019-07-10 |