| NPI | 1477800738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 016-0133850) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 19736) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2019-11-20 |