| NPI | 1629630074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN25738) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600218) |
| Enumeration Date | 2019-07-06 |
| Last Update Date | 2022-07-22 |