| NPI | 1457974198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858646) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24903) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2020-06-02 |