| NPI | 1588276257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417175) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN25721) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02809600) | |
| Enumeration Date | 2020-08-23 |
| Last Update Date | 2023-07-19 |