| NPI | 1659749679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC DGD.8741 GD) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000255) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2017-02-10 |