| NPI | 1508395849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401418142) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12012753A) |
| 1223G0001X Dentist, General Practice (Licence: IL 019031465) | |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2022-10-07 |