| NPI | 1467948539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401417649) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16416) |
| 122300000X Dentist (Licence: MD 16416) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2023-03-02 |