| NPI | 1497137517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2018044499) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030181) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2024-07-31 |