| NPI | 1659931350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416645) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16895) |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2023-06-26 |