| NPI | 1629794987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 016.0134279) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN27571) |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2024-06-10 |