| NPI | 1477006260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415313) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001648) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2021-09-10 |